成人期股骨头骨骺滑脱症的全髋关节置换

发布时间：2018-05-27 10:48

本文选题：股骨头骨骺滑脱 + 股骨头　；参考：《中国矫形外科杂志》2017年05期

【摘要】：[目的]探讨全髋关节置换术治疗成人期股骨头滑脱继发股骨头颈短缩畸形的临床疗效。[方法]2009年9月~2014年1月应用全髋关节置换术治疗成人期股骨头滑脱患者28例(30髋),男21例,女7例;年龄27岁~66岁,平均(48.6±9.3)岁。通过真臼重建、梯度软组织松解和撬拨复位良好地实现了髋关节置换。术后对患者满意度、髋关节功能恢复和双下肢长度恢复等情况进行评估。[结果]所有患者均获得随访,随访时间15~72个月,平均(38.5±3.7)个月。Harris髋关节评分由术前(48.1±4.5)分(41~62分)提高至末次随访时的(93.1±3.8)分(88~96分),术前及术后髋关节功能的差异有统计学意义(t=27.31,P0.001)。其中优18例(20髋)、良10例(10髋),优良率100%。28例髋术后均立即实现了髋臼及股骨柄的生物性压配与初始稳定,术后3个月X线片上均获骨性固定。2例术后有腓总神经牵拉损伤症状,未行特殊处理,应用神经营养药物及保持下肢膝关节屈膝位,2~3周后下肢麻木消失,术后4周左右下肢肌力均完全恢复正常。随访期间无髋关节脱位、假体感染及松动发生。[结论]全髋关节置换术治疗成人期股骨头滑脱合并股骨头颈短缩可获得令人满意的手术效果,采用梯次松解法可对髋周软组织挛缩进行有效松解。
[Abstract]:Objective: to investigate the clinical effect of total hip arthroplasty in the treatment of femoral head short contraction deformity secondary to femoral head spondylolisthesis. [methods] from September 2009 to January 2014, 28 adult patients with femoral head spondylolisthesis were treated with total hip arthroplasty, including 21 males and 7 females, with a mean age of 48.6 卤9.3 years. The hip arthroplasty was achieved through the reconstruction of the true acetabulum, gradient soft tissue release and pry reduction. Patient satisfaction, hip function and lower limb length were evaluated after operation. [results] all the patients were followed up for 15 ~ 72 months, with an average of 38.5 卤3.7 months. Harris hip joint score increased from 48.1 卤4.5 to 8896 at the last follow-up. The difference between preoperative and postoperative hip joint function was statistically significant. The excellent and good rate was 100. 28 hips. The biological pressure matching and initial stabilization of acetabular and femoral petiole were achieved immediately after operation. Bone fixation was found in 2 cases with common peroneal nerve traction injury 3 months after operation. Without special treatment, the lower extremity numbness disappeared 3 weeks after the application of neurotrophic drugs and maintained the knee flexion of the lower extremities, and the muscle strength of the lower limbs completely recovered to normal at about 4 weeks after operation. During follow-up, no dislocation of hip joint, prosthetic infection and loosening occurred. [conclusion] Total hip arthroplasty in the treatment of adult femoral head spondylolisthesis with short femoral head neck contraction can obtain satisfactory results, the use of ladder relaxation method can be used to release the soft tissue contracture around the hip.
【作者单位】：兰州军区兰州总医院全军骨科中心关节外科;
【分类号】：R687.4

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